Vaginal dryness like vasomotor symptoms should be easy to treat with
estrogens. After the menopause women lose collagen from the skin, ligaments,
bone matrix, the genital tract and bladder which can be corrected with
hormone replacement.(29) These patients with symptoms of pelvic atrophy
should have the same low dose oestradiol, with the appropriate progestogen
if necessary, for as long as it takes to eradicate the symptoms. Local
vaginal oestradiol or oestriol can be used. Progestogen is not
normally added to this therapy although endometrial proliferation and
hyperplasia may rarely occur. If bladder symptoms of urgency and
recurrent “cystitis” are present a higher dose may be required
for a longer duration regardless of whether the route of administration
is local oral or transdermal.